嗅鞘细胞治疗脊髓损伤的研究进展

随着交通事故、外伤以及运动性损伤的不断增加,脊髓损伤呈上升的趋势。脊髓损伤引起截瘫,致残率很高,给患者本人、家人、社会带来了沉重的负担。目前,脊髓损伤仍然是一个世界性的难题。随着人们对脊髓损伤的病理改变、生化改变以及分子生物等方面的研究不断深入,各种治疗方法不断被报道,嗅鞘细胞移植治疗是目前认为最有可能取得突破性进展的治疗方法之一。本文就嗅鞘细胞治疗脊髓损伤进行综述。     

破骨细胞在强直性脊柱炎滑膜组织浸润及与软骨破坏的相关性

目的 检测强直性脊柱炎(ankylosing spandylifts,AS)患者滑膜组织中破骨细胞浸润,探讨破骨细胞与软骨破坏相父性.方法 采用酶组织化学技术检测滑膜组织内破骨细胞,Mankin评分检测软骨破坏情况,Leika Qwin高清晰图像分析系统测定阳性染色而积,相关分析分析破骨细胞表达与软骨破坏的相关性.结果 破骨细胞在滑膜组织内阳性浸润,并主要分布在滑膜衬里层及滑膜与软骨交界处,阳性染色而积与对照组有显著差异,破骨细胞的浸润与软骨的破坏程度显著相关(r=0.654,P=0.001).结论 AS滑膜组织中有破骨细胞浸润,并与软骨的破坏程度具有相关性,在As骨与软骨的破坏过程中发挥着重要的作用.     

尤因肉瘤生物治疗基础研究的现状

生物治疗对于预后不良的尤因肉瘤(Ewing’s sarcoma,又称尤文肉瘤)患者具有更好的临床意义,其类型包括基因治疗、免疫治疗、抗血管生成靶向治疗等。尤因肉瘤的基因治疗主要体现在反义核酸技术的应用;免疫治疗主要体现在抗体疗法、T细胞疗法、DC疗法和肿瘤疫苗治疗等方面;抗血管生成治疗主要体现在抑制肿瘤血管的生成,从而抑制肿瘤的生长和迁移。随着研究的深入,发现端粒长度的变化、微粒体谷胱甘肽转移酶1（microsomal glutathione Stransferase 1,MGST1）表达水平、肿瘤转移和多药耐药相关基因的表达以及乳头状瘤病毒结合因子等都有可能成为尤因内瘤预后的判断指标。     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

磷酸钙骨水泥的研究进展综述

磷酸钙骨水泥的研究进展综述林立波曾维权骨缺损的修复重建是骨科的一个重要课题。虽然新鲜自体骨是修复重建的一种有效材料，但因供骨来源有限，且增加手术创伤，使其临床应用受到很大限制。寻求合适的骨替代材料用于骨缺损的生物性重建是其出路所在。近几十年来，着...     

NMDAr和Non-NMDAr受体拮抗剂在脊神经节损伤所介导痛觉过敏中的作用

目的：采用N-甲基-D-天门冬氨基酸（NMDAr）受体竞争拮抗剂AP－5和非N-甲基-D-天门冬氨基酸（Non－NMDAI）受体拮抗剂CNQX,研究脊髓背角NMDAr和Non－NMDAr受体在DRG炎性损伤所致的伤侧肢体痛觉过敏中的作用。方法：健康家兔42只。实验分为：Ⅰ组（AP－5）;Ⅱ组（CNQX）Ⅲ组（0．9％生理盐水）。测定用药前后动物神经和脊髓背角Glu和ASp含量变化。结果：DRG炎性损伤造成脊髓背角EAAS（Glu,Asp）释放增加。结论：NMDAr和Non－NMDAr受体的激活,在伤侧肢体痛觉过敏的形成和维持中具有重要作用。Non－NMDAr受体主要介导温度性痛觉过敏,而NMDAr受体在机械性刺激和温度性痛觉过敏中均具有重要作用。Ap－5和CNQX蛛网膜下腔注射,能显著减轻DRG炎性损伤所造成伤侧肢体痛觉过敏。     

后路经关节螺钉内固定相关解剖的螺旋CT多平面重建测量

目的通过对正常人寰枢椎的螺旋CT多平面重建检查，对其行后路经关节螺钉内固定术（Magerl术）相关形态学参数的测量，为临床提供患者个体化手术相关信息。方法对60例正常人进行寰枢椎的螺旋CT检查，在获取的多平面CT重建图像上按照Magerl术模拟手术。并对颈椎双侧C2峡部高度和宽度、理想的螺钉长度、理想的螺钉上倾角及内倾角．以及理想的螺钉路径与椎动脉沟之间距离进行测量。结果C2峡部高度为（8．02±1．92）mm，峡部宽度（6．05±1．32）mm，理想的螺钉长度为（37．22±3．08）mm，螺钉上倾角为（50．18±4．25）°，内倾角（8．31±2．52）°。10侧（8．3％）峡部狭窄（宽度或高度小于5mm）；35侧（29．2％）矢状面啊建图像可见到椎动脉沟．其中16侧（13．3％）椎动脉沟与理想螺钉途径之间距离小于2．5mm。这12侧中也包含了4例峡部狭窄的患者，因此总共有22侧（18.3％）存在解剖变异，其行Magerl术时有损伤椎动脉风险。结论行后路经关节螺钉固定术前对每个患者行寰枢椎CT检查十分重要，能充分的了解其解剖结构的个体差异．可提高手术的安全性。     

三维CT引导下寰枢椎椎弓根螺钉治疗上颈椎不稳

目的 观察在三维CT引导下后路寰枢椎椎弓根螺钉的置钉准确率及其治疗上颈椎不稳的近期疗效.方法 7例上颈椎不稳患者在三维CT引导下行后路寰枢椎椎弓根钉固定术并行自体髂骨植骨融合,其中先天性齿突不连3例,寰枢不稳3例,陈旧性齿突骨折1例.结果 所有病例术后随访3～15个月,临床症状得到不同程度的改善,融合节段获得骨性融...     

组织工程髓核的研究进展

椎间盘退变性疾病是现代社会中一种常见病和多发病,是引起下腰痛最常见的病因,严重影响患者生活质量[1].组织工程修复椎间盘退变是近年来脊柱外科领域基础研究的热点,研究开发符合椎间盘结构与功能的移植物,对退变椎间盘进行功能重建,已成为治疗椎间盘退变性疾病比较理想的解决方案[2].     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.